Pancreatic endocrine cancer - Insulinomul

Pancreatic endocrine cancer - Insulinomul

    * Introduction
    * Signs and symptoms
    * Diagnosis
    * Treatment
Insulinomul tumor is an island pancreatic beta cells that cause hypersecretion of insulin. It is more common in women and small tumors under 2 cm, 90% are benign. Insulinoamele produce an increased secretion of insulin lowers glucose levels.
Typical symptoms are that patients complain about hypoglycemia and include: fatigue, fatigue, tremors and hunger. Many patients have to eat very often to prevent symptoms. Some of them have developed psychiatric simptomje caused by hypoglycemia.
Diagnosis is made by simultaneous measurement of glucose and insulin levels in the blood.
Of all insulinoamele 80% are unique and can be effectively resected if identified. Only 10% are malignant. Insulinoamele occurring ratio of 1 / 250. 000 people at the age of 50 years, except for people with MEN type I syndrome (10% of insulinoame), when it debuts in 20 years. Insulinoamele associated with MEN type I are often multiple. Insulinoamele are the most common malignant tumors of the pancreas.
In a first line treatment is surgical resection insulinom with a cure rate of 90%. If it can not be removed completely and the symptoms persist, drugs such as diazoxide and octreotide can maintain blood sugar within reasonable limits. Chemotherapy with streptozotocin and 5-fluorouracil are useful in therapy insulinomului.
Pathogenesis and causes
Insulinomul is a tumor derived from neuroendocrine cells that produce insulin in the island and excess. Insulinoame 90% are benign. In healthy people insulin and C peptide are secreted in amounts equimolare because both derive from the same inactive precursor, proinsulin. Normal less than 20% of the proinsulin is released directly into circulation.
Some insulinoame secrete additional hormones such as gastrin, 5-hidroxiindolic acid, adrenocorticotropina-ACTH, glucagon, somatostatin and human chorionic gonadotropin. The tumor can secrete insulin in short flows in the blood forcing its fluctuations. Approximately 10% of insulinoame are malignant, with metastasis and 10% are multiple, in particular multiple endocrine neoplasia in patients with MEN type I. Of those 50% have multiple insulinoame MEN I. On the other hand 21% of patients with menu insulinoame develop. How insulinoame 5% of MEN I syndrome are associated with that family members should be tested for this disease.
Genetic causes are suspected. MEN gene, an autosomal dominant disease is called MEN1. This is supposed to function as a tumor suppressor gene. New discoveries suggest that the MEN1 gene is involved in the pathogenesis of neuroendocrine tumors. Scientists have detected the loss of band 11q13 in heterozygous nature of DNA samples from resected insulinoamele with microsatellite analysis using fluorescent. A study showed that K-RAS gene mutation is present in 23% of insulinoame.